Clinical Case Database / Category: Patient Management

Syncope

Publication details

Dr Joe Sawyer, Dr Mark J Dayer
Foundation Years Journal, volume 8, issue 2, p.48 (123Doc Education, London, February 2014)

Abstract

Syncope is defined as a transient loss of consciousness and is a specific term that excludes seizures, coma, shock or other altered states of consciousness. It is extremely common and frequently presents to the emergency department. Evaluation of the event through a detailed medical history will form the basis of the diagnostic strategy and will enable the stratification of patients according to risk.

This article provides a simple approach on how to assess, investigate and evaluate patient risk. Furthermore we categorise syncope into its different causes providing a diagnostic framework and management plan for each. Some syncopal episodes may be easily diagnosed on history alone whereas others may require a careful diagnostic workup involving specialist input.

The management of syncope is entirely dependant on the cause and can vary from supportive measures to invasive procedures. This highlights the importance of the initial history and subsequent diagnostic investigations.

This article will provide junior doctors with the confidence to manage syncope in the busy emergency department allowing them to make important decisions on whether to admit or discharge.

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Authors

Dr Joe Sawyer

FY2, Accident and Emergency Department,
Taunton and Somerset NHS Trust, Musgrove Park, Taunton, TA1 5DA
joseph.sawyer05@gmail.com

Dr Mark J Dayer

Consultant Cardiologist,
Taunton and Somerset NHS Trust, Musgrove Park, Taunton, TA1 5DA
mark.dayer@tst.nhs.uk

References

1. Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al. Incidence and prognosis of syncope. The New England journal of medicine. 2002;347(12):878-85. Epub 2002/09/20.
2. Saccilotto RT, Nickel CH, Bucher HC, Steyerberg EW, Bingisser R, Koller MT. San Francisco Syncope Rule to predict short-term serious outcomes: a systematic review. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. 2011;183(15):E1116-26. Epub 2011/09/29.
3. Ungar A, Del Rosso A, Giada F, Bartoletti A, Furlan R, Quartieri F, et al. Early and late outcome of treated patients referred for syncope to emergency department: the EGSYS 2 follow-up study. European heart journal. 2010;31(16):2021-6. Epub 2010/02/20.
4. Ammirati F, Colivicchi F, Minardi G, De Lio L, Terranova A, Scaffidi G, et al. [The management of syncope in the hospital: the OESIL Study (Osservatorio Epidemiologico della Sincope nel Lazio)]. Giornale italiano di cardiologia. 1999;29(5):533-9. Epub 1999/06/15. Gestione della sincope in ospedale: lo Studio OESIL (Osservatorio Epidemiologico della Sincope nel Lazio).
5. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al. Guidelines for the diagnosis and management of syncope (version 2009). European heart journal. 2009;30(21):2631-71. Epub 2009/08/29.
6. Croci F, Brignole M, Alboni P, Menozzi C, Raviele A, Del Rosso A, et al. The application of a
standardized strategy of evaluation in patients with syncope referred to three syncope units. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2002;4(4):351-5. Epub 2002/11/01.
7. Rogers G, O’Flynn N. NICE guideline: transient loss of consciousness (blackouts) in adults and young people. The British journal of general practice : the journal of the Royal College of General Practitioners. 2011;61(582):40-2. Epub 2011/03/16.
8. Sheldon R, Connolly S, Rose S, Klingenheben T, Krahn A, Morillo C, et al. Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation. 2006;113(9):1164-70. Epub 2006/03/01.
9. Raj SR, Rose S, Ritchie D, Sheldon RS. The Second Prevention of Syncope Trial (POST II)--a randomized clinical trial of fludrocortisone for the prevention of neurally mediated syncope: rationale and study design. American heart journal. 2006;151(6):1186 e11-7. Epub 2006/06/20.
10. Raj SR, Faris PD, McRae M, Sheldon RS. Rationale for the prevention of syncope trial IV: assessment of midodrine. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. 2012;22(6):275-80. Epub 2012/05/23.
11. Brignole M, Menozzi C, Moya A, Andresen D, Blanc JJ, Krahn AD, et al. Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial. Circulation. 2012;125(21):2566-71. Epub 2012/05/09.

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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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